Health initiative eyes improvement for veteran access to care

Updated 8:39 pm, Monday, September 19, 2016

HARLINGEN — A top Veterans Affairs official said Monday that an initiative to remove bureaucratic entanglements in the veterans health care system will speed access to care for veterans in the Rio Grande Valley, and could act as a model for the rest of the country.

The conclusion of a 90-day initiative to streamline community care programs for veterans has already decreased the denial rate for claims from 50 percent to 10 percent, and officials say they expect other improvements in the months ahead.

“The simplest way to say this,” explained Richard Stone, principal deputy undersecretary for health for the VA, “is this is a commitment to pay our bills.”

For decades, tens of thousands of veterans spread across deep South Texas, which lacks a VA hospital, faced a six-hour round trip or longer to receive care at the Audie Murphy VA Hospital in San Antonio.

To address disparities in access to care, Congress in 2014 created the Veterans Choice Program. Aimed at giving eligible veterans the option of seeing private doctors, the program has been fraught with complications and done little to reduce lengthy wait times for health care.

Veterans in the Valley say the choice program failed to deliver on its promises to improve care, and many health care providers argue the system is burdensome, which has disrupted their ability to serve veterans.

Responding to concerns, U.S. Rep. Ruben Hinojosa, D-Edinburg, in June urged health care providers, the VA and TriWest Healthcare Alliance, a third-party contractor that helps the VA administer the choice program, to identify problems in the network, then strengthen it by cutting through the red tape.

“What we found out is that we didn’t talk to each other very well at all,” Stone said. “We created bureaucratic barriers to talking to each other.”

Though officials provided few details on the changes that will take place as a result of the initiative, among the findings were delays in payment on provider claims, unpaid claims because of filing errors, and a health care system that was sending correspondence to the wrong address.

The choice program is seen as important to reducing extended wait times for the more than 30,000 veterans living in Valley. During the 90-day initiative, 1,800 providers served around 22,000 veterans. That number will grow as retirees who winter in communities along the border return in the coming months.

Hinojosa said his office has created a one-page guide that will be sent to providers in his district, including information on authorizations and medical documentation.

“The objective was to take a look at where are the gaps in the process to make sure all of the pieces come together,” said Dave McIntyre, CEO and President of TriWest. “You can’t get this right unless the bills get paid properly.”